Caregivers need help as Hawaii’s population ages

Editorial | Our ViewOriginally published by the Honolulu Star-Advertiser Editorial Board on February 12, 2017. Read it there.

Well, Hawaii, we’re not getting any younger.

According to state data, by 2020, most of the baby boomers — those born between 1946 and 1964 — will have celebrated their 60th birthday. By then, it’s projected that about one-quarter of the state’s population will be age 60 or older. Demographers say that as a state, we’re aging more rapidly and living longer than any other state.

And given the combination of a desire to live at home for as long as possible and the savings-busting expense often tied to assisted-care living, family members are increasingly providing long-term care to kupuna. According to AARP, there are 154,000 unpaid family caregivers in Hawaii, with the average caregiver being a 62-year-old woman caring for an elderly parent or husband while still working.

Senate Bill 534 aims to establish a kupuna caregivers program to help such caregivers remain in the workforce. Eligible caregivers would get a voucher of $70 a day, which would be applied to bills for home care aids and others who can provide adult day care, transportation, personal care and various homemaking services.

The bill is a good idea — a good fit for Hawaii, which currently has the highest percentage of ohana households in the nation. According to a U.S. Census survey conducted a few years ago, 11.3 percent of all family households in the islands were multigenerational — three or more generations — while the national average was 5.8 percent.

According to SB 534, voucher recipients must be employed 30 or more hours a week and caring for a Hawaii resident who is at least 60 years old, contending with functional impairment and not residing in a skilled nursing, assisted-living or other adult residential care facility.

While assisting families in need is the right thing to do, the scope of a kupuna caregivers program should be carefully probed before launch because it has the potential to quickly drain public coffers.

Critics might say the program — which would start with about $600,000 from the state’s general fund for fiscal 2017-18 to draft a study of program logistics, gate-keeping rules and other matters, followed by $6 million in 2018-19 for implementation — adds up to a social services handout. However, the employment requirement ensures that the state would benefit from the program. While the state pays for respite services, it would continue to count on economic benefits, such as tax revenue, as a result of helping caregivers maintain stable employment.

The respite voucher could help reduce the necessity for time off from work for emergencies, and lower the numbers of caregivers who must resign from jobs when they can no longer juggle employment and caregiving. Anyone who has ever been the go-to caregiver for a family member knows about the potentially heavy stresses that come with such responsibility.

Critics might argue that funding eldercare is not the government’s responsibility and point to generations of families that have shouldered caregiving expenses on their own. But the household pocketbook profile in Hawaii and elsewhere across the nation is changing.

Over the last four decades, demographers say, the portion of U.S. households tagged as middle-income has steadily shrunk. And few families living on a tight budget elect to pay into private long-term care insurance policies, according to Caring Across Generations, a national group that helped organize a rally at the state Capitol last week to support the bill.

The nonprofit said that families without such policies typically face two choices: drain life savings in order to qualify for Medicaid paid-for nursing home residential care or rely on unpaid family caregivers. For most, neither yields a sustainable solution.

The proposed kupuna caregivers program would expand on some respite-related services already available through the state’s Executive Office on Aging, housed in the Department of Health. Supporters say that by providing the $70-a-day care benefit, the bill establishes a “care floor,” ensuring that working families would have access to resources to provide kupuna care. It should also set a spending ceiling and put in place financial-need eligibility requirements.

The so-called “silver tsunami” is rolling in. The oldest of the baby boomers have already marked their 70th birthday. In Hawaii, our lifespan expectancy is 81.3 years, topping the national average by 2.3 years.

Now is the time to take a hard look at eldercare challenges confronting the state and make careful plans to address them.